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Headache is the symptom of
pain Pain is a distressing feeling often caused by intense or damaging stimuli. The defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." In medical ...
in the
face The face is the front of an animal's head that features the eyes Eyes are organs An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tis ...

face
,
head Head Sport GmbH is an American-Austrian headquartered in . It owns the American tennis racket brand Head. Head GmbH is a group that includes several previously independent companies, including the original "Head Ski Company" (founded in the in ...

head
, or
neck The neck is the part of the body on many vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular eukaryotic organisms that form the Kingdom (biology), biological kingdom Animalia. With f ...

neck
. It can occur as a
migraine A migraine (, ) is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically, episodes affect one side of the head, are pulsating in nature, and last from a few hours to three days. Associated sympto ...

migraine
,
tension-type headache Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common type of primary headache Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or clu ...
, or
cluster headache Cluster headache (CH) is a neurological disorder A neurological disorder is any disorder of the nervous system In Biology, biology, the nervous system is a Complex system, highly complex part of an animal that coordinates its Behavior, ac ...
. There is an increased risk of
depression Depression may refer to: Mental health * Depression (mood), a state of low mood and aversion to activity * Mood disorders characterized by depression are commonly referred to as simply ''depression'', including: ** Dysthymia ** Major depressive ...
in those with severe headaches. Headaches can occur as a result of many conditions. There are a number of different classification systems for headaches. The most well-recognized is that of the
International Headache Society The International Headache Society (IHS) is a London-based charity membership organisation founded in 1981 for those with a professional commitment to helping people affected by headache Headache is the symptom of pain in the face, head, or n ...
which classifies it into more than 150 types of
primary Primary or primaries may refer to: Arts, entertainment, and media Music Groups and labels * Primary (band), from Australia * Primary (musician), hip hop musician and record producer from South Korea * Primary Music, Israeli record label Works * ...
and secondary headaches. Causes of headaches may include dehydration, fatigue, sleep deprivation, stress, the effects of medications(overuse) and recreational drugs, including withdrawal, viral infections, loud noises, common colds, head injury, rapid ingestion of a very cold food or beverage, and dental or sinus issues (such as
sinusitis Sinusitis, also known as rhinosinusitis, is inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irrit ...

sinusitis
). Treatment of a headache depends on the underlying cause, but commonly involves
pain medication An analgesic or painkiller is any member of the group of drugs used to achieve analgesia, relief from pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines p ...
(especially in case of migraine or cluster headache). A headache is one of the most commonly experienced of all physical discomforts. About half of adults have a headache in a given year. Tension headaches are the most common, affecting about 1.6 billion people (21.8% of the population) followed by migraine headaches which affect about 848 million (11.7%).


Causes

There are more than 200 types of headaches. Some are harmless and some are
life-threatening Lethality (also called deadliness or perniciousness) is how capable something is of causing death (1906) Death is the permanent, Irreversible process, irreversible cessation of all biological process, biological functions that sustain a ...
. The description of the headache and findings on
neurological examination A neurological examination is the assessment of sensory neuron and motor neuron, motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's ...
, determine whether additional tests are needed and what treatment is best. Headaches are broadly classified as "primary" or "secondary". Primary headaches are benign, recurrent headaches not caused by underlying disease or structural problems. For example,
migraine A migraine (, ) is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically, episodes affect one side of the head, are pulsating in nature, and last from a few hours to three days. Associated sympto ...

migraine
is a type of primary headache. While primary headaches may cause significant daily pain and disability, they are not dangerous from a physiological point of view. Secondary headaches are caused by an underlying disease, like an
infection An infection is the invasion of an organism's body by , their multiplication, and the reaction of tissues to the infectious agents and the s they produce. An infectious disease, also known as a transmissible disease or communicable disease, i ...
,
head injury A head injury is any injury that results in trauma to the skull The skull is a bone A bone is a Stiffness, rigid tissue (anatomy), tissue that constitutes part of the skeleton in most vertebrate animals. Bones protect the various orga ...

head injury
,
vascular disorders Vascular disease is a class of diseases of the blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues ...
, brain bleed,
stomach irritation The stomach is a muscular, Organ (anatomy), hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital Digestion, digestive organ. ...
, or
tumors A neoplasm () is a type of abnormal and excessive growth of Tissue (biology), tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissu ...
. Secondary headaches can be dangerous. Certain "red flags" or warning signs indicate a secondary headache may be dangerous.


Primary

Ninety percent of all headaches are primary headaches. Primary headaches usually first start when people are between 20 and 40 years old. The most common types of primary headaches are migraines and tension-type headaches. They have different characteristics. Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light) and phonophobia (sensitivity to sound) Tension-type headaches usually present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms. Such kind of headaches maybe further classified into- episodic and chronic tension type headaches Other very rare types of primary headaches include: *
cluster headache Cluster headache (CH) is a neurological disorder A neurological disorder is any disorder of the nervous system In Biology, biology, the nervous system is a Complex system, highly complex part of an animal that coordinates its Behavior, ac ...
s: short episodes (15–180 minutes) of severe pain, usually around one eye, with autonomic symptoms (tearing, red eye, nasal congestion) which occur at the same time every day. Cluster headaches can be treated with triptans and prevented with prednisone, ergotamine or lithium. *
trigeminal neuralgia Trigeminal neuralgia (TN or TGN) is a long-term pain disorder that affects the trigeminal nerve The trigeminal nerve (the fifth cranial nerve, or simply CN V) is a nerve responsible for sensation in the face and motor functions such as biting ...
or
occipital neuralgia Occipital neuralgia (ON) is a painful condition affecting the posterior head in the distributions of the greater occipital nerve (GON), lesser occipital nerve (LON), third occipital nerve (TON), or a combination of the three. It is paroxysmal, last ...
: shooting face pain *
hemicrania continua Hemicrania continua (HC) is a persistent unilateral headache Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of Depression (mood), ...
: continuous unilateral pain with episodes of severe pain. Hemicrania continua can be relieved by the medication
indomethacin Indometacin, also known as indomethacin, is a nonsteroidal anti-inflammatory drug (NSAID) commonly used as a prescription medication to reduce fever, pain Pain is a distressing feeling often caused by intense or damaging stimuli. The Interna ...

indomethacin
. * primary stabbing headache: recurrent episodes of stabbing "ice pick pain" or "jabs and jolts" for 1 second to several minutes without autonomic symptoms (tearing, red eye, nasal congestion). These headaches can be treated with
indomethacin Indometacin, also known as indomethacin, is a nonsteroidal anti-inflammatory drug (NSAID) commonly used as a prescription medication to reduce fever, pain Pain is a distressing feeling often caused by intense or damaging stimuli. The Interna ...

indomethacin
. * primary cough headache: starts suddenly and lasts for several minutes after coughing, sneezing or straining (anything that may increase pressure in the head). Serious causes (see secondary headaches red flag section) must be ruled out before a diagnosis of "benign" primary cough headache can be made. * primary exertional headache: throbbing, pulsatile pain which starts during or after exercising, lasting for 5 minutes to 24 hours. The mechanism behind these headaches is unclear, possibly due to straining causing veins in the head to dilate, causing pain. These headaches can be prevented by not exercising too strenuously and can be treated with medications such as
indomethacin Indometacin, also known as indomethacin, is a nonsteroidal anti-inflammatory drug (NSAID) commonly used as a prescription medication to reduce fever, pain Pain is a distressing feeling often caused by intense or damaging stimuli. The Interna ...

indomethacin
. * primary sex headache: dull, bilateral headache that starts during sexual activity and becomes much worse during orgasm. These headaches are thought to be due to lower pressure in the head during sex. It is important to realize that headaches that begin during orgasm may be due to a subarachnoid hemorrhage, so serious causes must be ruled out first. These headaches are treated by advising the person to stop sex if they develop a headache. Medications such as
propranolol Propranolol, sold under the brand name Inderal among others, is a medication of the class. It is used to treat , a number of types of , , s, , and s, as well to prevent , and to prevent further heart problems in those with or previous . It c ...

propranolol
and
diltiazem Diltiazem, sold under the brand name Cardizem among others, is a calcium channel blocker medication used to treat high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Disease, medical condit ...

diltiazem
can also be helpful. * hypnic headache: moderate-severe headache that starts a few hours after falling asleep and lasts 15–30 minutes. The headache may recur several times during night. Hypnic headaches are usually in older women. They may be treated with
lithium Lithium (from el, λίθος, lithos, lit=stone) is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up matter to the composed of s, s and s: the ...
.


Secondary

Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as
cervicogenic headacheCervicogenic headache is a type of headache characterised by chronic hemicranial pain referred to the head from either the cervical spine or soft tissues within the neck. The main symptoms of cervicogenic headaches include pain originating in the nec ...
(pain arising from the neck muscles). The excessive use of painkillers can paradoxically cause worsening painkiller headaches. More serious causes of secondary headaches include the following: *
meningitis Meningitis is an acute Acute may refer to: Science and technology * Acute angle ** Acute triangle ** Acute, a leaf shape in the glossary of leaf morphology#acute, glossary of leaf morphology * Acute (medicine), a disease that it is of short dur ...
:
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the natural science that studies life and living organisms, including their anato ...
of the meninges which presents with fever and meningismus, or stiff neck * bleeding inside the brain (
intracranial hemorrhage Intracranial hemorrhage (ICH), also known as intracranial bleed, is bleeding within the skull The skull is a bone A bone is a Stiffness, rigid tissue (anatomy), tissue that constitutes part of the vertebrate skeleton in animals. Bones p ...
) *
subarachnoid hemorrhage Subarachnoid hemorrhage (SAH) is bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressi ...
(acute, severe headache, stiff neck without fever) * ruptured aneurysm,
arteriovenous malformation Arteriovenous malformation is an abnormal connection between arteries and veins, bypassing the capillary system. This vascular anomaly is widely known because of its occurrence in the central nervous system (usually cerebral AVM), but can app ...
,
intraparenchymal hemorrhage Intraparenchymal hemorrhage (IPH) is one form of intracerebral bleeding in which there is bleeding within brain parenchyma Parenchyma () is the bulk of functional substance in an animal organ or structure such as a tumour. In zoology Zool ...
(headache only) *
brain tumor A brain tumor occurs when abnormal cells form within the brain A brain is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on ...
: dull headache, worse with exertion and change in position, accompanied by nausea and vomiting. Often, the person will have nausea and vomiting for weeks before the headache starts. * temporal arteritis: inflammatory disease of arteries common in the elderly (average age 70) with fever, headache, weight loss, jaw claudication, tender vessels by the temples, polymyalgia rheumatica * (increased pressure in the eyeball): headache that starts with eye pain, blurry vision, associated with nausea and vomiting. On physical exam, the person will have a red eye and a fixed, mid dilated pupil. * Post-ictal headaches: Headaches that happen after a convulsion or other type of seizure, as part of the period after the seizure (the post-ictal state)
Gastrointestinal disorders Gastrointestinal diseases (abbrev. GI diseases or GI illnesses) refer to diseases involving the Human gastrointestinal tract, gastrointestinal tract, namely the oesophagus, stomach, small intestine, large intestine and rectum, and the accessory orga ...
may cause headaches, including
Helicobacter pylori ''Helicobacter pylori'', previously known as ''Campylobacter pylori'', is a gram-negative, microaerophile, microaerophilic, spiral bacteria, spiral (helical) bacterium usually found in the stomach. Its helical shape (from which the genus name, ...

Helicobacter pylori
infection,
celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
,
non-celiac gluten sensitivity Non-celiac gluten sensitivity (NCGS) or gluten sensitivity is "a clinical entity induced by the ingestion of gluten Gluten is a group of seed storage protein Proteins are large biomolecules or macromolecules that are comprised of one or more ...
,
irritable bowel syndrome Irritable bowel syndrome (IBS), referred to previously as spastic or nervous colon, and spastic bowel, is a functional gastrointestinal disorder Functional may refer to: * Movements in architecture: ** Functionalism (architecture) In archit ...

irritable bowel syndrome
,
inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammation, inflammatory conditions of the colon (anatomy), colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine an ...
,
gastroparesis Gastroparesis (gastro- from Ancient Greek γαστήρ - gaster, "stomach"; and -paresis, πάρεσις - "partial paralysis"), also called delayed gastric emptying, is a medical disorder consisting of weak muscular contractions (peristalsis) of t ...
, and hepatobiliary disorders. The treatment of the gastrointestinal disorders may lead to a remission or improvement of headaches. Migraine headaches are also associated with
Cyclic Vomiting Syndrome Cyclic vomiting syndrome (CVS) is a chronic functional condition of unknown pathogenesis Pathogenesis is the process by which a disease or Disease#Disorder, disorder develops. It can include factors which contribute not only to the onset of the ...
(CVS). CVS is characterized by episodes of severe vomiting, and often occur alongside symptoms similar to those of migraine headaches (photophobia, abdominal pain, etc).


Pathophysiology

The
brain A brain is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tis ...

brain
itself is not sensitive to
pain Pain is a distressing feeling often caused by intense or damaging stimuli. The defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." In medical ...
, because it lacks pain receptors. However, several areas of the
head Head Sport GmbH is an American-Austrian headquartered in . It owns the American tennis racket brand Head. Head GmbH is a group that includes several previously independent companies, including the original "Head Ski Company" (founded in the in ...

head
and
neck The neck is the part of the body on many vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular eukaryotic organisms that form the Kingdom (biology), biological kingdom Animalia. With f ...

neck
do have pain receptors and can thus sense pain. These include the extracranial arteries,
middle meningeal artery The middle meningeal artery ('' la, arteria meningea media'') is typically the third branch of the first portion of the maxillary artery Maxillary means "related to the maxilla The maxilla (plural: ''maxillae'' ) in vertebrates is the upper ...

middle meningeal artery
, large veins,
venous sinuses The dural venous sinuses (also called dural sinuses, cerebral sinuses, or cranial sinuses) are vein, venous channels found between the Endosteum, endosteal and Meninges, meningeal layers of dura mater in the brain. They receive blood from the cereb ...
, cranial and spinal nerves, head and neck muscles, the
meninges In anatomy Anatomy (Greek ''anatomē'', 'dissection') is the branch of concerned with the study of the structure of s and their parts. Anatomy is a branch of natural science which deals with the structural organization of living things. I ...

meninges
,
falx cerebri The falx cerebri, also known as the cerebral falx, is a large, crescent-shaped fold of meningeal layer of dura mater Dura mater is a thick membrane made of dense irregular connective tissue that surrounds the brain and spinal cord. It is the ou ...

falx cerebri
, parts of the brainstem, eyes, ears, teeth and lining of the mouth. Pial arteries, rather than pial veins are responsible for pain production. Headaches often result from traction to or irritation of the meninges and blood vessels. The pain receptors may be stimulated by head trauma or tumors and cause headaches. Blood vessel spasms, dilated
blood vessels The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an organ system An organ system is a biological system A biological system is a co ...

blood vessels
, inflammation or infection of meninges and muscular tension can also stimulate pain receptors. Once stimulated, a
nociceptor A nociceptor ("pain receptor") is a sensory neuron Sensory neurons, also known as afferent neurons, are neuron A neuron or nerve cell is an membrane potential#Cell excitability, electrically excitable cell (biology), cell that communicates w ...
sends a message up the length of the nerve fiber to the nerve cells in the brain, signalling that a part of the body hurts. Primary headaches are more difficult to understand than secondary headaches. The exact mechanisms which cause migraines, tension headaches and cluster headaches are not known. There have been different hypotheses over time that attempt to explain what happens in the brain to cause these headaches. Migraines are currently thought to be caused by dysfunction of the nerves in the brain. Previously, migraines were thought to be caused by a primary problem with the blood vessels in the brain. This vascular theory, which was developed in the 20th century by Wolff, suggested that the aura in
migraines A migraine (, ) is a primary headache disorderThe International Classification of Headache Disorders (ICHD) is a detailed hierarchical A hierarchy (from the Greek: , from , 'president of sacred rites') is an arrangement of items (objects, na ...
is caused by constriction of intracranial vessels (vessels inside the brain), and the headache itself is caused by rebound dilation of extracranial vessels (vessels just outside the brain). Dilation of these extracranial blood vessels activates the pain receptors in the surrounding nerves, causing a headache. The vascular theory is no longer accepted. Studies have shown migraine head pain is not accompanied by extracranial vasodilation, but rather only has some mild intracranial vasodilation. Currently, most specialists think migraines are due to a primary problem with the nerves in the brain. Auras are thought to be caused by a wave of increased activity of neurons in the
cerebral cortex The cerebral cortex, also known as the cerebral mantle, is the outer layer of neural tissue of the cerebrum of the brain in humans and other mammals. The cerebral cortex mostly consists of the six-layered neocortex, with just 10% consisting of a ...
(a part of the brain) known as cortical spreading depression followed by a period of depressed activity. Some people think headaches are caused by the activation of
sensory nerves A sensory nerve, also called an afferent nerve, is a nerve that carries sensory system, sensory information toward the central nervous system (CNS) and all those nerves which can sense or recognise the stimulie (Internal or External) are known as ...
which release peptides or serotonin, causing inflammation in arteries, dura and meninges and also cause some vasodilation.
Triptan Triptans are a family of tryptamine-based medication, drugs used as abortive medication in the treatment of migraines and cluster headaches. This drug class was first introduced in the 1990s. While effective at treating individual headaches, they ...
s, medications which treat migraines, block serotonin receptors and constrict blood vessels. People who are more susceptible to experience migraines without headache are those who have a family history of migraines, women, and women who are experiencing hormonal changes or are taking
birth control pillsOral contraceptives, abbreviated OCPs, also known as birth control pills, are medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, t ...

birth control pills
or are prescribed
hormone replacement therapy Hormone replacement therapy (HRT), also known as menopausal hormone therapy or postmenopausal hormone therapy, is a form of hormone therapy Hormone therapy or hormonal therapy is the use of hormones in medical treatment. Treatment with hormone a ...
.
Tension headaches Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for ...
are thought to be caused by activation of peripheral nerves in the head and neck muscles.
Cluster headaches Cluster headache (CH) is a neurological disorder A neurological disorder is any disorder of the nervous system In Biology, biology, the nervous system is a Complex system, highly complex part of an animal that coordinates its Behavior, ac ...
involve overactivation of the
trigeminal nerve The trigeminal nerve (the fifth cranial nerve, or simply CN V) is a nerve responsible for sensation in the face and motor functions such as biting and chewing; it is the most complex of the cranial nerves Cranial nerves are the nerve A ner ...

trigeminal nerve
and
hypothalamus The hypothalamus (from Ancient Greek wikt:ὑπό, ὑπό, "under", and wikt:θάλαμος, θάλαμος, "chamber") is a portion of the brain that contains a number of small Nucleus (neuroanatomy), nuclei with a variety of functions. One of ...

hypothalamus
in the brain, but the exact cause is unknown.


Diagnosis

Most headaches can be diagnosed by the clinical history alone. If the symptoms described by the person sound dangerous, further testing with neuroimaging or lumbar puncture may be necessary. Electroencephalography (EEG) is not useful for headache diagnosis. The first step to diagnosing a headache is to determine if the headache is old or new. A "new headache" can be a headache that has started recently, or a chronic headache that has changed character. For example, if a person has chronic weekly headaches with pressure on both sides of his head, and then develops a sudden severe throbbing headache on one side of his head, they have a new headache.


Red flags

It can be challenging to differentiate between low-risk, benign headaches and high-risk, dangerous headaches since symptoms are often similar. Headaches that are possibly dangerous require further lab tests and imaging to diagnose. The American College for Emergency Physicians published criteria for low-risk headaches. They are as follows: * age younger than 30 years * features typical of primary headache * history of similar headache * no abnormal findings on neurologic exam * no concerning change in normal headache pattern * no high-risk comorbid conditions (for example, HIV) * no new concerning history or physical examination findings A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes which may be life-threatening or cause long-term damage. These "red flag" symptoms mean that a headache warrants further investigation with neuroimaging and lab tests. In general, people complaining of their "first" or "worst" headache warrant imaging and further workup. People with progressively worsening headache also warrant imaging, as they may have a mass or a bleed that is gradually growing, pressing on surrounding structures and causing worsening pain. People with neurological findings on exam, such as weakness, also need further workup. The American Headache Society recommends using "SSNOOP", a mnemonic to remember the red flags for identifying a secondary headache: * Systemic symptoms (fever or weight loss) * Systemic disease (HIV infection, malignancy) * Neurologic symptoms or signs * Onset sudden (thunderclap headache) * Onset after age 40 years * Previous headache history (first, worst, or different headache) Other red flag symptoms include:


Old headaches

Old headaches are usually primary headaches and are not dangerous. They are most often caused by
migraines A migraine (, ) is a primary headache disorderThe International Classification of Headache Disorders (ICHD) is a detailed hierarchical A hierarchy (from the Greek: , from , 'president of sacred rites') is an arrangement of items (objects, na ...
or
tension headaches Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for ...
. Migraines are often unilateral, pulsing headaches accompanied by nausea or vomiting. There may be an aura (visual symptoms, numbness or tingling) 30–60 minutes before the headache, warning the person of a headache. Migraines may also not have auras. Tension type headaches usually have bilateral "bandlike" pressure on both sides of the head usually without nausea or vomiting. However, some symptoms from both headache groups may overlap. It is important to distinguish between the two because the treatments are different. The mnemonic 'POUND' helps distinguish between migraines and tension type headaches. POUND stands for: One review article found that if 4–5 of the POUND characteristics are present, migraine is 24 times as likely a diagnosis than tension type headache (
likelihood ratio The likelihood function (often simply called the likelihood) describes the joint probability Given random variables X,Y,\ldots, that are defined on a probability space, the joint probability distribution for X,Y,\ldots is a probability distributi ...
24). If 3 characteristics of POUND are present, migraine is 3 times more likely a diagnosis than tension type headache (
likelihood ratio The likelihood function (often simply called the likelihood) describes the joint probability Given random variables X,Y,\ldots, that are defined on a probability space, the joint probability distribution for X,Y,\ldots is a probability distributi ...
3). If only 2 POUND characteristics are present, tension type headaches are 60% more likely (likelihood ratio 0.41). Another study found the following factors independently each increase the chance of migraine over tension type headache: nausea, photophobia, phonophobia, exacerbation by physical activity, unilateral, throbbing quality, chocolate as headache trigger, cheese as headache trigger.
Cluster headaches Cluster headache (CH) is a neurological disorder A neurological disorder is any disorder of the nervous system In Biology, biology, the nervous system is a Complex system, highly complex part of an animal that coordinates its Behavior, ac ...
are relatively rare (1 in 1000 people) and are more common in men than women. They present with sudden onset explosive pain around one eye and are accompanied by autonomic symptoms (tearing, runny nose and red eye). Temporomandibular jaw pain (chronic pain in the jaw joint), and
cervicogenic headacheCervicogenic headache is a type of headache characterised by chronic hemicranial pain referred to the head from either the cervical spine or soft tissues within the neck. The main symptoms of cervicogenic headaches include pain originating in the nec ...
(headache caused by pain in muscles of the neck) are also possible diagnoses. For chronic, unexplained headaches, keeping a headache diary can be useful for tracking symptoms and identifying triggers, such as association with menstrual cycle, exercise and food. While mobile electronic diaries for smartphones are becoming increasingly common, a recent review found most are developed with a lack of evidence base and scientific expertise.


New headaches

New headaches are more likely to be dangerous secondary headaches. They can, however, simply be the first presentation of a chronic headache syndrome, like migraine or tension-type headaches. One recommended diagnostic approach is as follows. If any urgent
red flags Red is the color at the long wavelength end of the visible spectrum of light, next to Orange (colour), orange and opposite Violet (color), violet. It has a dominant wavelength of approximately 625–740 nanometres. It is a primary color in the ...
are present such as visual loss, new seizures, new weakness, new confusion, further workup with imaging and possibly a lumbar puncture should be done (see red flags section for more details). If the headache is sudden onset (thunderclap headache), a computed tomography test to look for a brain bleed (
subarachnoid hemorrhage Subarachnoid hemorrhage (SAH) is bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressi ...
) should be done. If the CT scan does not show a bleed, a lumbar puncture should be done to look for blood in the CSF, as the CT scan can be falsely negative and subarachnoid hemorrhages can be fatal. If there are signs of infection such as fever, rash, or stiff neck, a lumbar puncture to look for meningitis should be considered. If there is jaw claudication and scalp tenderness in an older person, a temporal artery biopsy to look for temporal arteritis should be performed and immediate treatment should be started.


Neuroimaging


Old headaches

The US Headache Consortium has guidelines for neuroimaging of non-acute headaches. Most old, chronic headaches do not require neuroimaging. If a person has the characteristic symptoms of a migraine, neuroimaging is not needed as it is very unlikely the person has an intracranial abnormality., which cites * * * If the person has neurological findings, such as weakness, on exam, neuroimaging may be considered.


New headaches

All people who present with
red flags Red is the color at the long wavelength end of the visible spectrum of light, next to Orange (colour), orange and opposite Violet (color), violet. It has a dominant wavelength of approximately 625–740 nanometres. It is a primary color in the ...
indicating a dangerous secondary headache should receive neuroimaging. The best form of neuroimaging for these headaches is controversial. Non-contrast computerized tomography (CT) scan is usually the first step in head imaging as it is readily available in Emergency Departments and hospitals and is cheaper than MRI. Non-contrast CT is best for identifying an acute head bleed. Magnetic Resonance Imaging (MRI) is best for brain tumors and problems in the posterior fossa, or back of the brain. MRI is more sensitive for identifying intracranial problems, however it can pick up brain abnormalities that are not relevant to the person's headaches. The American College of Radiology recommends the following imaging tests for different specific situations:


Lumbar puncture

A
lumbar puncture Lumbar puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal The spinal canal (or vertebral canal or spinal cavity) is the canal that contains the spinal cord The spinal cord ...
is a procedure in which cerebral spinal fluid is removed from the spine with a needle. A lumbar puncture is necessary to look for infection or blood in the spinal fluid. A lumbar puncture can also evaluate the pressure in the spinal column, which can be useful for people with
idiopathic intracranial hypertension Idiopathic intracranial hypertension (IIH), previously known as pseudotumor cerebri and benign intracranial hypertension, is a condition characterized by increased intracranial pressure Intracranial pressure (ICP) is the pressure exerted by fluid ...
(usually young, obese women who have increased intracranial pressure), or other causes of increased intracranial pressure. In most cases, a CT scan should be done first.


Classification

Headaches are most thoroughly classified by the
International Headache Society The International Headache Society (IHS) is a London-based charity membership organisation founded in 1981 for those with a professional commitment to helping people affected by headache Headache is the symptom of pain in the face, head, or n ...
's International Classification of Headache Disorders (ICHD), which published the second edition in 2004. The third edition of the International Headache Classification was published in 2013 in a beta version ahead of the final version. This classification is accepted by the
WHO The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nations and each other through the co-ordinating machinery of the Unite ...

WHO
. Other classification systems exist. One of the first published attempts was in 1951. The US
National Institutes of Health The National Institutes of Health (NIH ) is the primary agency of the United States government The federal government of the United States (U.S. federal government or U.S. government) is the national government of the United States ...
developed a classification system in 1962.


ICHD-2

The
International Classification of Headache DisordersThe International Classification of Headache Disorders (ICHD) is a detailed hierarchical classification Classification is a process related to categorization Categorization is the human ability and activity of recognizing shared features or sim ...
(ICHD) is an in-depth
hierarchical A hierarchy (from Ancient Greek, Greek: , from , 'president of sacred rites') is an arrangement of items (objects, names, values, categories, etc.) that are represented as being "above", "below", or "at the same level as" one another. Hierarchy i ...

hierarchical
classification of headaches published by the
International Headache Society The International Headache Society (IHS) is a London-based charity membership organisation founded in 1981 for those with a professional commitment to helping people affected by headache Headache is the symptom of pain in the face, head, or n ...
. It contains explicit (operational)
diagnostic criteria Medical diagnosis (abbreviated Dx or DS) is the process of determining which disease or condition explains a person's symptoms and signs. It is most often referred to as diagnosis with the medical Medicine is the art, science Science ...
for headache disorders. The first version of the classification, ICHD-1, was published in 1988. The current revision, ICHD-2, was published in 2004. The classification uses numeric codes. The top, one-digit diagnostic level includes 14 headache groups. The first four of these are classified as primary headaches, groups 5-12 as secondary headaches,
cranial Standard anatomical terms of location deal unambiguously with the anatomy Anatomy (Greek ''anatomē'', 'dissection') is the branch of biology concerned with the study of the structure of organism In biology, an organism (from Ancient ...
neuralgia Neuralgia (Greek ''neuron'', "nerve" + ''algos'', "pain") is pain in the distribution of a nerve or nerves, as in intercostal neuralgia, trigeminal neuralgia, and glossopharyngeal nerve, glossopharyngeal neuralgia. Classification Under the gene ...
, central and primary facial pain and other headaches for the last two groups. The ICHD-2 classification defines
migraine A migraine (, ) is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically, episodes affect one side of the head, are pulsating in nature, and last from a few hours to three days. Associated sympto ...

migraine
s, tension-types headaches, cluster headache and other
trigeminal The trigeminal nerve (the fifth cranial nerve, or simply CN V) is a nerve A nerve is an enclosed, cable-like bundle of fibers (called axon An axon (from Greek ἄξων ''áxōn'', axis), or nerve fiber (or nerve fibre: see spelling d ...
autonomic headache as the main types of primary headaches. Also, according to the same classification, stabbing headaches and headaches due to
cough A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes A microorganism, or microbe,, ''mikros'', "small") and ''organism In biology, ...
, exertion and sexual activity (
sexual headache Sexual headache is a type of headache that occur in the human skull, skull and neck during sexual activity, including masturbation or orgasm. These headaches are usually benign, but occasionally are caused by intracranial hemorrhage and cerebral in ...
) are classified as primary headaches. The daily-persistent headaches along with the hypnic headache and thunderclap headaches are considered primary headaches as well. Secondary headaches are classified based on their cause and not on their
symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality show ...

symptoms
. According to the ICHD-2 classification, the main types of secondary headaches include those that are due to head or neck trauma such as whiplash injury, intracranial hematoma, post
craniotomy A craniotomy is a surgical operation Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical or dental specialty that uses operative manual and instrumental techn ...
or other head or neck injury. Headaches caused by cranial or cervical vascular disorders such as
ischemic stroke A stroke is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not due to any immediate external injury. Di ...

ischemic stroke
and
transient ischemic attack A transient ischemic attack (TIA), commonly known as a mini-stroke, is a brief episode of neurological dysfunction caused by loss of blood flow (ischemia Ischemia or ischaemia is a restriction in blood Blood is a body fluid in humans and ...
, non-traumatic intracranial hemorrhage, vascular malformations or
arteritis Arteritis is the inflammation of the walls of arteries, usually as a result of infection An infection is the invasion of an organism's body Tissue (biology), tissues by Pathogen, disease-causing agents, their multiplication, and the reaction o ...
are also defined as secondary headaches. This type of headaches may also be caused by cerebral venous thrombosis or different intracranial vascular disorders. Other secondary headaches are those due to intracranial disorders that are not vascular such as low or high pressure of the cerebrospinal fluid pressure, non-infectious inflammatory disease, intracranial neoplasm,
epileptic seizure An epileptic seizure, formally known as a seizure, is a period of symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower tempe ...
or other types of disorders or diseases that are intracranial but that are not associated with the vasculature of the
central nervous system The central nervous system (CNS) is the part of the nervous system In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecu ...

central nervous system
. ICHD-2 classifies headaches that are caused by the ingestion of a certain substance or by its withdrawal as secondary headaches as well. This type of headache may result from the overuse of some medications or by exposure to some substances.
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus ''Lentivirus'' is a genus Genus (plural genera) is a taxonomic rank Taxonomy (general) is the practice and science of classification of things or concepts, inc ...

HIV
/
AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection An infection is the invasion of an organism's body by , their multiplication, and the reaction of ...
, intracranial
infections An infection is the invasion of an organism's body Tissue (biology), tissues by Pathogen, disease-causing agents, their multiplication, and the reaction of host (biology), host tissues to the infectious agents and the toxins they produce. An in ...
and systemic infections may also cause secondary headaches. The ICHD-2 system of classification includes the headaches associated with homeostasis disorders in the category of secondary headaches. This means that headaches caused by
dialysis In medicine, dialysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its populatio ...

dialysis
,
high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank ...
,
hypothyroidism Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland The thyroid, or thyroid gland, is an endocrine gland in the neck consisting of two ...

hypothyroidism
, and cephalalgia and even
fasting Fasting is the willful refrainment from eating Eating (also known as consuming) is the ingestion Ingestion is the consumption of a substance by an organism In biology, an organism (from Ancient Greek, Greek: ὀργανισμός, ...

fasting
are considered secondary headaches. Secondary headaches, according to the same classification system, can also be due to the injury of any of the facial structures including
teeth A tooth (plural teeth) is a hard, calcified Calcification is the accumulation of calcium salts in a Tissue (biology), body tissue. It normally occurs in the formation of bone, but calcium can be deposited abnormally in soft tissue,Miller, J. ...

teeth
, jaws, or
temporomandibular joint In anatomy Anatomy (Greek ''anatomē'', 'dissection') is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science which deals with the structural organization of ...

temporomandibular joint
. Headaches caused by psychiatric disorders such as
somatizationSomatization is a tendency to experience and communicate psychological distress in the form of somatic symptoms and to seek medical help for them. More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such a ...
or
psychotic disorders Psychosis is a condition of the mind that results in difficulties determining what is Reality, real and what is not real. Symptoms may include delusions and hallucinations. Other symptoms may include thought disorder, incoherent speech and beha ...
are also classified as secondary headaches. The ICHD-2 classification puts cranial neuralgias and other types of
neuralgia Neuralgia (Greek ''neuron'', "nerve" + ''algos'', "pain") is pain in the distribution of a nerve or nerves, as in intercostal neuralgia, trigeminal neuralgia, and glossopharyngeal nerve, glossopharyngeal neuralgia. Classification Under the gene ...
in a different category. According to this system, there are 19 types of neuralgias and headaches due to different central causes of facial pain. Moreover, the ICHD-2 includes a category that contains all the headaches that cannot be classified. Although the ICHD-2 is the most complete headache classification there is and it includes frequency in the diagnostic criteria of some types of headaches (primarily primary headaches), it does not specifically code frequency or severity which are left at the discretion of the examiner.


NIH

The NIH classification consists of brief definitions of a limited number of headaches. The NIH system of classification is more succinct and only describes five categories of headaches. In this case, primary headaches are those that do not show organic or structural cause. According to this classification, primary headaches can only be vascular,
myogenicThe myogenic mechanism is how artery, arteries and arterioles react to an increase or decrease of blood pressure to keep the blood flow constant within the blood vessel. Myogenic response refers to a contraction initiated by the myocyte itself instea ...
, cervicogenic, traction and inflammatory.


Management

Primary headache syndromes have many different possible treatments. In those with chronic headaches the long term use of opioids appears to result in greater harm than benefit.


Migraines

Migraine A migraine (, ) is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically, episodes affect one side of the head, are pulsating in nature, and last from a few hours to three days. Associated sympt ...
can be somewhat improved by lifestyle changes, but most people require medicines to control their symptoms. Medications are either to prevent getting migraines, or to reduce symptoms once a migraine starts. Preventive medications are generally recommended when people have more than four attacks of migraine per month, headaches last longer than 12 hours or the headaches are very disabling. Possible therapies include beta blockers, antidepressants, anticonvulsants and NSAIDs. The type of preventive medicine is usually chosen based on the other symptoms the person has. For example, if the person also has depression, an antidepressant is a good choice. Abortive therapies for migraines may be oral, if the migraine is mild to moderate, or may require stronger medicine given intravenously or intramuscularly. Mild to moderate headaches should first be treated with
acetaminophen Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. At a standard dose, paracetamol only slightly decreases body temperature; it is inferior to ibuprofen in that respect, and the benefits of ...

acetaminophen
(paracetamol) or NSAIDs, like
ibuprofen Ibuprofen is a medication in the nonsteroidal anti-inflammatory drug (NSAID) class that is used for treating pain, fever, and inflammation. This includes dysmenorrhea, painful menstrual periods, migraines, and rheumatoid arthritis. It may also ...

ibuprofen
. If accompanied by nausea or vomiting, an antiemetic such as metoclopramide (Reglan) can be given orally or rectally. Moderate to severe attacks should be treated first with an oral
triptan Triptans are a family of tryptamine-based medication, drugs used as abortive medication in the treatment of migraines and cluster headaches. This drug class was first introduced in the 1990s. While effective at treating individual headaches, they ...
, a medication that mimics serotonin (an agonist) and causes mild vasoconstriction. If accompanied by nausea and vomiting, parenteral (through a needle in the skin) triptans and antiemetics can be given. Sphenopalatine ganglion block (SPG block, also known nasal ganglion block or
pterygopalatine ganglion The pterygopalatine ganglion (aka Meckel's ganglion, nasal ganglion, SPG or sphenopalatine ganglion) is a parasympathetic ganglion found in the pterygopalatine fossa. It is largely innervated by the greater petrosal nerve (a branch of the facial ...
blocks) can abort and prevent migraines, tension headaches and cluster headaches. It was originally described by American ENT surgeon Greenfield Sluder in 1908. Both blocks and neurostimulation have been studied as treatment for headaches. Several complementary and alternative strategies can help with migraines. The American Academy of Neurology guidelines for migraine treatment in 2000 stated
relaxation training A relaxation technique (also known as relaxation training) is any method, process, procedure, or activity that helps a person to relax; to attain a state of increased calmness; or otherwise reduce levels of pain, anxiety, Stress (biology), stress ...
, electromyographic feedback and
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (e. ...
may be considered for migraine treatment, along with medications.


Tension-type headaches

Tension-type headache Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common type of primary headache Headache is the symptom of pain Pain is a distressing feeling often caused by intense or damaging stimuli. The ...
s can usually be managed with NSAIDs (
ibuprofen Ibuprofen is a medication in the nonsteroidal anti-inflammatory drug (NSAID) class that is used for treating pain, fever, and inflammation. This includes dysmenorrhea, painful menstrual periods, migraines, and rheumatoid arthritis. It may also ...

ibuprofen
,
naproxen Naproxen, sold under the brand name Aleve or Apronax among others, is a nonsteroidal anti-inflammatory drug Nonsteroidal anti-inflammatory drugs (NSAIDs) are members of a drug class File:Aspirine macro shot.jpg, Uncoated aspirin Table ...

naproxen
,
aspirin Aspirin, also known as acetylsalicylic acid (ASA), is a medication used to reduce pain, fever, or inflammation. Specific inflammatory conditions which aspirin is used to treat include Kawasaki disease, pericarditis, and rheumatic fever. Aspirin ...

aspirin
), or
acetaminophen Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. At a standard dose, paracetamol only slightly decreases body temperature; it is inferior to ibuprofen in that respect, and the benefits of ...

acetaminophen
.
Triptans Triptans are a family of tryptamine-based drugs Uncoated tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and binders. Aspirin is a pharmaceutical drug A medication (also referred to as ...
are not helpful in tension-type headaches unless the person also has migraines. For chronic tension type headaches,
amitriptyline Amitriptyline, sold under the brand name Elavil among #Brand names, others, is a tricyclic antidepressant primarily used to treat major depressive disorder and a variety of pain syndromes from neuropathic pain to fibromyalgia to migraine and ten ...

amitriptyline
is the only medication proven to help. Amitriptyline is a medication which treats depression and also independently treats pain. It works by blocking the reuptake of serotonin and norepinephrine, and also reduces muscle tenderness by a separate mechanism. Studies evaluating acupuncture for tension-type headaches have been mixed. Overall, they show that acupuncture is probably not helpful for tension-type headaches.


Cluster headaches

Abortive therapy for cluster headaches includes subcutaneous sumatriptan (injected under the skin) and triptan nasal sprays. High flow oxygen therapy also helps with relief. For people with extended periods of cluster headaches, preventive therapy can be necessary. Verapamil is recommended as first line treatment. Lithium can also be useful. For people with shorter bouts, a short course of prednisone (10 days) can be helpful. Ergotamine is useful if given 1–2 hours before an attack.


Secondary headaches

Treatment of secondary headaches involves treating the underlying cause. For example, a person with meningitis will require antibiotics. A person with a
brain tumor A brain tumor occurs when abnormal cells form within the brain A brain is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on ...
may require surgery,
chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment Cancer Cancer is a group of diseases A disease is a particular abnormal condition that negatively affects the structure or f ...

chemotherapy
or brain radiation.


Neuromodulation

Peripheral neuromodulation has tentative benefits in primary headaches including cluster headaches and chronic migraine. How it may work is still being looked into.


Epidemiology

Literature review A literature review is an overview of the previously published works on a specific topic. The term can refer to a full scholarly paper or a section of a scholarly work such as a book, or an article. Either way, a literature review is supposed t ...
s find that approximately 64–77% of adults have had a headache at some point in their lives. During each year, on average, 46–53% of people have headaches. However, the
prevalence In epidemiology Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants In mathematics, the determinant is a Scalar (mathematics), scalar value that is a function (mathematics), function of ...

prevalence
of headache varies widely depending on how the survey was conducted, with studies finding lifetime prevalence of as low as 8% to as high as 96%. Most of these headaches are not dangerous. Only approximately 1–5% of people who seek emergency treatment for headaches have a serious underlying cause. More than 90% of headaches are primary headaches. Most of these primary headaches are tension headaches. Most people with tension headaches have "episodic" tension headaches that come and go. Only 3.3% of adults have chronic tension headaches, with headaches for more than 15 days in a month. Approximately 12–18% of people in the world have migraines. More women than men experience migraines. In Europe and North America, 5–9% of men experience migraines, while 12–25% of women experience migraines. Cluster headaches are relatively uncommon. They affect only 1–3 per thousand people in the world. Cluster headaches affect approximately three times as many men as women.


History

The first recorded classification system was published by
Aretaeus of Cappadocia Aretaeus ( grc-gre, Ἀρεταῖος) is one of the most celebrated of the ancient Greek physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simpl ...

Aretaeus of Cappadocia
, a medical scholar of Greco-Roman
antiquity Antiquity or Antiquities may refer to Historical objects or periods Artifacts * Antiquities, objects or artifacts surviving from ancient cultures Eras Any period before the European Middle Ages In the history of Europe, the Middle Ages ...
. He made a distinction between three different types of headache: i) cephalalgia, by which he indicates a shortlasting, mild headache; ii) cephalea, referring to a chronic type of headache; and iii) heterocrania, a paroxysmal headache on one side of the head. Another classification system that resembles the modern ones was published by
Thomas Willis Thomas Willis Fellow of the Royal Society, FRS (27 January 1621 – 11 November 1675) was an English doctor who played an important part in the history of anatomy, neurology and psychiatry. He was a founding member of the Royal Society. Life ...

Thomas Willis
, in ''De Cephalalgia'' in 1672. In 1787 Christian Baur generally divided headaches into
idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparent wikt:spontaneous, spontaneous origin. From Ancient Greek, Greek ἴδιος ''idios'' "one's own" and πάθος ''pathos'' "suffering", ''idiopathy'' means approxi ...
(primary headaches) and
symptomatic Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...
(secondary ones), and defined 84 categories.


Children

In general, children suffer from the same types of headaches as adults do, but their symptoms may be slightly different. The diagnostic approach to headache in children is similar to that of adults. However, young children may not be able to verbalize pain well. If a young child is fussy, they may have a headache. Approximately 1% of emergency department visits for children are for headache. Most of these headaches are not dangerous. The most common type of headache seen in pediatric emergency rooms is headache caused by a cold (28.5%). Other headaches diagnosed in the emergency department include post-traumatic headache (20%), headache related to a problem with a
ventriculoperitoneal shunt Cerebral shunts are commonly used to treat hydrocephalus, the swelling of the brain due to excess buildup of Cerebrospinal fluid, cerebrospinal fluid (CSF). If left unchecked, the cerebrospinal fluid can build up leading to an increase in Intracra ...
(a device put into the brain to remove excess CSF and reduce pressure in the brain) (11.5%) and migraine (8.5%). The most common serious headaches found in children include brain bleeds (
subdural hematoma A subdural hematoma (SDH) is a type of bleeding in which a Hematoma, collection of blood—usually associated with a traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding th ...
,
epidural hematoma Epidural hematoma is when bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either throug ...

epidural hematoma
),
brain abscess A brain is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tiss ...
es, meningitis and
ventriculoperitoneal shunt Cerebral shunts are commonly used to treat hydrocephalus, the swelling of the brain due to excess buildup of Cerebrospinal fluid, cerebrospinal fluid (CSF). If left unchecked, the cerebrospinal fluid can build up leading to an increase in Intracra ...
malfunction. Only 4–6.9% of kids with a headache have a serious cause. Just as in adults, most headaches are benign, but when head pain is accompanied with other symptoms such as speech problems,
muscle weakness Muscle weakness is a lack of muscle Skeletal muscles (commonly referred to as muscles) are organs An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A gi ...
, and
loss of vision Visual impairment, also known as vision impairment or vision loss, is a decreased ability to visual perception, see to a degree that causes problems not fixable by usual means, such as glasses. Some also include those who have a decreased abilit ...
, a more serious underlying cause may exist:
hydrocephalus :''This article concerns the medical condition. For the hydrocephalus creature in American folklore that bares this condition as a part of its legend, see melon heads In the American folklore of Ohio, Michigan and Connecticut, Melon Heads are b ...

hydrocephalus
,
meningitis Meningitis is an acute Acute may refer to: Science and technology * Acute angle ** Acute triangle ** Acute, a leaf shape in the glossary of leaf morphology#acute, glossary of leaf morphology * Acute (medicine), a disease that it is of short dur ...
,
encephalitis Encephalitis is inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the natural science that studies life and living ...
,
abscess An abscess is a collection of pus Pus is an exudate An exudate is a fluid emitted by an organism through pores or a wound, a process known as exuding or exudation. ''Exudate'' is derived from ''exude'', "to ooze", from the Latin Lat ...

abscess
,
hemorrhage Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrients and oxygen to the Cell (biology), cells and transports ...
,
tumor A neoplasm () is a type of abnormal and excessive growth of tissue Tissue may refer to: Biology * Tissue (biology), an ensemble of similar cells that together carry out a specific function * ''Triphosa haesitata'', a species of geometer moth ...

tumor
,
blood clot A thrombus, colloquially called a blood clot, is the final product of the blood coagulation Coagulation, also known as clotting, is the process by which blood Blood is a body fluid in humans and other animals that delivers necessary sub ...

blood clot
s, or
head trauma A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of injur ...
. In these cases, the headache evaluation may include CT scan or MRI in order to look for possible structural disorders of the
central nervous system The central nervous system (CNS) is the part of the nervous system In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecu ...

central nervous system
. If a child with a recurrent headache has a normal physical exam, neuroimaging is not recommended. Guidelines state children with abnormal neurologic exams, confusion, seizures and recent onset of worst headache of life, change in headache type or anything suggesting neurologic problems should receive neuroimaging. When children complain of headaches, many parents are concerned about a
brain tumor A brain tumor occurs when abnormal cells form within the brain A brain is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on ...
. Generally, headaches caused by brain masses are incapacitating and accompanied by vomiting. One study found characteristics associated with brain tumor in children are: headache for greater than 6 months, headache related to sleep, vomiting, confusion, no visual symptoms, no family history of migraine and abnormal neurologic exam. Some measures can help prevent headaches in children. Drinking plenty of water throughout the day, avoiding caffeine, getting enough and regular sleep, eating balanced meals at the proper times, and reducing stress and excess of activities may prevent headaches. Treatments for children are similar to those for adults, however certain medications such as narcotics should not be given to children. Children who have headaches will not necessarily have headaches as adults. In one study of 100 children with headache, eight years later 44% of those with tension headache and 28% of those with migraines were headache free. In another study of people with chronic daily headache, 75% did not have chronic daily headaches two years later, and 88% did not have chronic daily headaches eight years later.


References


External links

* {{Authority control Symptoms and signs Medical mnemonics